Comparison of Perioperative Outcomes and Urethral Complications Between Using 24-French and 26-French Resectoscope Sheaths in Holmium Laser Enucleation of the Prostate

Abstract

Aim: Although the 26F resectoscope is frequently used in transurethral prostatectomy, there are some concerns with high-caliber shafts. We compared 24F and 26F resectoscope used for Holmium Laser Enucleation of the Prostate (HoLEP) in terms of effects on postoperative urethral complications and perioperative outcomes. Methods: Data from patients undergoing HoLEP from 2017 to 2021 was retrospectively analyzed. All surgeries were completed by a single surgeon. The patients were divided into one of two groups according to the resectoscope diameter (24F or 26F). All patients were followed up for urethral complications for 12 months. Perioperative outcomes and urethral complications were compared between the groups. Results: The study included 301 patients. The mean age of patients was 68.5 +/- 8.3 and 69.1 +/- 8.6 for the 26F group (n=180) and the 24F group (n=121), respectively (p=0.608). A total of seven in the 26F group (3.8%) and 3 patients in the 24F group (2.4%) had postoperative urethral stricture (US) (p=0.503). Besides, 2 patients (26F) and 1 patient (24F) had postoperative bladder neck contracture (BNC) (p=0.807). The operation efficiency was 1.25 g/min in the 26F group and 1.17 g/min in the 24F group (p=0.005). Conclusion: The use of 24F or 26F RS was not shown to cause statistically significant differences in the incidence of US and BNC during the 12-month follow-up. The use of the 24F RS significantly reduces surgical and morcellation efficiency.